Neck nodular fasciitis mimicking malignant cervical lymphadenopathy: a case report

Introduction: Cervical nodular fasciitis (NF), previously termed pseudosarcoma, is a benign, rapidly growing soft-tissue mass arising from fibroblasts or myoblasts. Associated lymphadenopathy is rare, and the presentation is often mistaken for metastatic malignancy or lymphoma. Case presentation: A 41-year-old man presented with a rapidly enlarging left-sided neck mass and multiple enlarged cervical lymph nodes. Computed tomography of the neck demonstrated a solid mass that was highly suspicious for a malignant lymph node. Histopathological examination following excisional biopsy revealed a spindle cell proliferation consistent with NF. Immunohistochemistry confirmed the diagnosis and excluded other malignant differential diagnoses. Clinical discussion: Cervical NF with associated lymphadenopathy is uncommon and can closely mimic lymphoma or metastatic lymphadenopathy clinically and radiologically. Histopathological examination with immunohistochemistry is essential for diagnosis. Complete surgical resection is both diagnostic and therapeutic and is associated with a low recurrence rate. Conclusion: Cervical NF rarely presents with multiple reactive cervical lymph nodes and may resemble lymphoma or metastatic lymphadenopathy. En bloc surgical excision is curative, with a low recurrence rate. A definitive diagnosis is usually established by histopathological and immunohistochemical examination.